Skip to main content
Top
Published in: Journal of Contemporary Psychotherapy 3/2016

Open Access 01-09-2016 | Original Paper

A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain

Authors: Whitney Scott, Katie E. J. Hann, Lance M. McCracken

Published in: Journal of Contemporary Psychotherapy | Issue 3/2016

Login to get access

Abstract

Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.
Literature
go back to reference Barnes-Holmes, D., & Barnes-Holmes, Y. (2000). Explaining complex behavior: Two perspectives on the concept of generalized operant classes. The Psychological Record, 50, 251–265. Barnes-Holmes, D., & Barnes-Holmes, Y. (2000). Explaining complex behavior: Two perspectives on the concept of generalized operant classes. The Psychological Record, 50, 251–265.
go back to reference Barnes-Holmes, D., Barnes-Holmes, Y., & Cullinan, V. (2000). Relational frame theory and skinner’s verbal behavior: A possible synthesis. The Behavior Analyst, 23, 69–84.PubMedPubMedCentral Barnes-Holmes, D., Barnes-Holmes, Y., & Cullinan, V. (2000). Relational frame theory and skinner’s verbal behavior: A possible synthesis. The Behavior Analyst, 23, 69–84.PubMedPubMedCentral
go back to reference Bergman, S., Jacobsson, L. T., Herrström, P., & Petersson, I. F. (2004). Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: A 3-year follow up study in the general population. Pain, 108, 115–123.CrossRefPubMed Bergman, S., Jacobsson, L. T., Herrström, P., & Petersson, I. F. (2004). Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: A 3-year follow up study in the general population. Pain, 108, 115–123.CrossRefPubMed
go back to reference Busija, L., Osborne, R. H., Nilsdotter, A., Buchbinder, R., & Roos, E. M. (2008). Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery. Health and Quality of Life Outcomes, 6, 1–12.CrossRef Busija, L., Osborne, R. H., Nilsdotter, A., Buchbinder, R., & Roos, E. M. (2008). Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery. Health and Quality of Life Outcomes, 6, 1–12.CrossRef
go back to reference Choi, Y., Mayer, T. G., Williams, M. J., & Gatchel, R. J. (2014). What is the best screening test for depression in chronic spinal pain patients? The Spine Journal, 14, 1175–1182.CrossRefPubMed Choi, Y., Mayer, T. G., Williams, M. J., & Gatchel, R. J. (2014). What is the best screening test for depression in chronic spinal pain patients? The Spine Journal, 14, 1175–1182.CrossRefPubMed
go back to reference Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
go back to reference Dahl, J., Luciano, C., & Wilson, K. G. (2005). Acceptance and commitment therapy for chronic pain. Reno, NV: Context Press. Dahl, J., Luciano, C., & Wilson, K. G. (2005). Acceptance and commitment therapy for chronic pain. Reno, NV: Context Press.
go back to reference Dahl, J., & Lundgren, T. (2006). Living beyond your pain: Using acceptance and commitment therapy to ease chronic pain. Oakland, CA: New Harbinger Publications. Dahl, J., & Lundgren, T. (2006). Living beyond your pain: Using acceptance and commitment therapy to ease chronic pain. Oakland, CA: New Harbinger Publications.
go back to reference Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., et al. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113, 9–19.CrossRefPubMed Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., et al. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113, 9–19.CrossRefPubMed
go back to reference Dymond, S., May, R. J., Munnelly, A., & Hoon, A. E. (2010). Evaluating the evidence base for relational frame theory: A citation analysis. Behavior Analyst, 33, 97–117.PubMedPubMedCentral Dymond, S., May, R. J., Munnelly, A., & Hoon, A. E. (2010). Evaluating the evidence base for relational frame theory: A citation analysis. Behavior Analyst, 33, 97–117.PubMedPubMedCentral
go back to reference Elliott, T. E., Renier, C. M., & Palcher, J. A. (2003). Chronic pain, depression, and quality of life: Correlations and predictive value of the SF-36. Pain Medicine, 4, 331–339.CrossRefPubMed Elliott, T. E., Renier, C. M., & Palcher, J. A. (2003). Chronic pain, depression, and quality of life: Correlations and predictive value of the SF-36. Pain Medicine, 4, 331–339.CrossRefPubMed
go back to reference Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., Teasdale, J. D., et al. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234–246.CrossRefPubMed Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., Teasdale, J. D., et al. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234–246.CrossRefPubMed
go back to reference Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., et al. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45, 83–101.CrossRefPubMed Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., et al. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45, 83–101.CrossRefPubMed
go back to reference Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. The Journal of Contextual Behavioral Science, 3, 217–227.CrossRef Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. The Journal of Contextual Behavioral Science, 3, 217–227.CrossRef
go back to reference Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44, 180–198.CrossRefPubMed Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44, 180–198.CrossRefPubMed
go back to reference Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.CrossRefPubMed Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.CrossRefPubMed
go back to reference Hayes, S. C., & Smith, S. (2005). Get out of your mind & into your life: The new acceptance & commitment therapy. Oakland: New Harbinger. Hayes, S. C., & Smith, S. (2005). Get out of your mind & into your life: The new acceptance & commitment therapy. Oakland: New Harbinger.
go back to reference Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.CrossRefPubMed Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.CrossRefPubMed
go back to reference McCracken, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Seattle: IASP Press. McCracken, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Seattle: IASP Press.
go back to reference McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14, 828–835.CrossRefPubMed McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14, 828–835.CrossRefPubMed
go back to reference McCracken, L. M., Barker, E., & Chilcot, J. (2014a). Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. Journal of Behavioral Medicine, 37, 1215–1225.CrossRefPubMed McCracken, L. M., Barker, E., & Chilcot, J. (2014a). Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. Journal of Behavioral Medicine, 37, 1215–1225.CrossRefPubMed
go back to reference McCracken, L., Chilcot, J., & Norton, S. (2014b). Further development in the assessment of psychological flexibility: A shortened committed action questionnaire (CAQ-8). European Journal of Pain, 14, 828–835.CrossRef McCracken, L., Chilcot, J., & Norton, S. (2014b). Further development in the assessment of psychological flexibility: A shortened committed action questionnaire (CAQ-8). European Journal of Pain, 14, 828–835.CrossRef
go back to reference McCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R. (2013). The cognitive fusion questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain. Clinical Journal of Pain, 30, 894–901.CrossRef McCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R. (2013). The cognitive fusion questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain. Clinical Journal of Pain, 30, 894–901.CrossRef
go back to reference McCracken, L. M., Davies, M., Scott, W., Paroli, M., Harris, S., & Sanderson, K. (2015). Can a psychologically based treatment help people to live with chronic pain when they are seeking a procedure to reduce it? Pain Medicine, 16, 451–459.CrossRefPubMed McCracken, L. M., Davies, M., Scott, W., Paroli, M., Harris, S., & Sanderson, K. (2015). Can a psychologically based treatment help people to live with chronic pain when they are seeking a procedure to reduce it? Pain Medicine, 16, 451–459.CrossRefPubMed
go back to reference McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164–169.CrossRefPubMed McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164–169.CrossRefPubMed
go back to reference McCracken, L. M., & Gutiérrez-Martínez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274.CrossRefPubMed McCracken, L. M., & Gutiérrez-Martínez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274.CrossRefPubMed
go back to reference McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221–234.CrossRefPubMed McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221–234.CrossRefPubMed
go back to reference McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166.CrossRefPubMed McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166.CrossRefPubMed
go back to reference McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335–1346.CrossRefPubMed McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335–1346.CrossRefPubMed
go back to reference Posternak, M. A., & Miller, I. (2001). Untreated short-term course of major depression: A meta-analysis of outcomes from studies using wait-list control groups. Journal of Affective Disorders, 66, 139–146.CrossRefPubMed Posternak, M. A., & Miller, I. (2001). Untreated short-term course of major depression: A meta-analysis of outcomes from studies using wait-list control groups. Journal of Affective Disorders, 66, 139–146.CrossRefPubMed
go back to reference Reneman, M. F., Dijkstra, A., Geertzen, J. H., & Dijkstra, P. U. (2010). Psychometric properties of chronic pain acceptance questionnaires: A systematic review. European Journal of Pain, 14, 457–465.CrossRefPubMed Reneman, M. F., Dijkstra, A., Geertzen, J. H., & Dijkstra, P. U. (2010). Psychometric properties of chronic pain acceptance questionnaires: A systematic review. European Journal of Pain, 14, 457–465.CrossRefPubMed
go back to reference Safran, J., & Segal, Z. V. (1996). Interpersonal process in cognitive therapy. Maryland: Roman & Littlefield Publishers Inc. Safran, J., & Segal, Z. V. (1996). Interpersonal process in cognitive therapy. Maryland: Roman & Littlefield Publishers Inc.
go back to reference Scott, W., & McCracken, L. M. (2015). Patients’ impression of change following treatment for chronic pain: global, specific, a single dimension, or many? The Journal of Pain, 16, 518–526.CrossRefPubMed Scott, W., & McCracken, L. M. (2015). Patients’ impression of change following treatment for chronic pain: global, specific, a single dimension, or many? The Journal of Pain, 16, 518–526.CrossRefPubMed
go back to reference Scott, W., McCracken, L. M., & Norton, S. (2015). A confirmatory factor analysis of facets of psychological flexibility in a sample of people seeking treatment for chronic pain. Annals of Behavioral Medicine, 2015, 1–12. Scott, W., McCracken, L. M., & Norton, S. (2015). A confirmatory factor analysis of facets of psychological flexibility in a sample of people seeking treatment for chronic pain. Annals of Behavioral Medicine, 2015, 1–12.
go back to reference Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the engaged living scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25, 1235–1246.CrossRefPubMed Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the engaged living scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25, 1235–1246.CrossRefPubMed
go back to reference Veehof, M. M., Oskam, M. J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152, 533–542.CrossRefPubMed Veehof, M. M., Oskam, M. J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152, 533–542.CrossRefPubMed
go back to reference Vowles, K. E., Fink, B. C., & Cohen, L. L. (2014a). Acceptance and commitment therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability. Journal of Contextual Behavioral Science, 3, 74–80.CrossRef Vowles, K. E., Fink, B. C., & Cohen, L. L. (2014a). Acceptance and commitment therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability. Journal of Contextual Behavioral Science, 3, 74–80.CrossRef
go back to reference Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397.CrossRefPubMed Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397.CrossRefPubMed
go back to reference Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2011). Acceptance and values-based action in chronic pain: A three year follow-up analysis of treatment effectiveness and process. Behaviour Research and Therapy, 49, 748–755.CrossRefPubMed Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2011). Acceptance and values-based action in chronic pain: A three year follow-up analysis of treatment effectiveness and process. Behaviour Research and Therapy, 49, 748–755.CrossRefPubMed
go back to reference Vowles, K. E., Witkiewitz, K., Sowden, G., & Ashworth, J. (2014b). Acceptance and commitment therapy for chronic pain: Evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. The Journal of Pain, 15, 101–113.CrossRefPubMed Vowles, K. E., Witkiewitz, K., Sowden, G., & Ashworth, J. (2014b). Acceptance and commitment therapy for chronic pain: Evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. The Journal of Pain, 15, 101–113.CrossRefPubMed
go back to reference Ware, J. E., Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 1992, 473–483.CrossRef Ware, J. E., Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 1992, 473–483.CrossRef
go back to reference Wicksell, R. K., Kemani, M., Jensen, K., Kosek, E., Kadetoff, D., Sorjonen, K., et al. (2013). Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial. European Journal of Pain, 17, 599–611.CrossRefPubMed Wicksell, R. K., Kemani, M., Jensen, K., Kosek, E., Kadetoff, D., Sorjonen, K., et al. (2013). Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial. European Journal of Pain, 17, 599–611.CrossRefPubMed
go back to reference Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in acceptance and commitment therapy for patients with chronic pain following whiplash. European Journal of Pain, 14, 1059.e1011–1059.e1051. Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in acceptance and commitment therapy for patients with chronic pain following whiplash. European Journal of Pain, 14, 1059.e1011–1059.e1051.
go back to reference Williams, A., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, 11, CD007407.PubMed Williams, A., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, 11, CD007407.PubMed
go back to reference Wittink, H., Turk, D. C., Carr, D. B., Sukiennik, A., & Rogers, W. (2004). Comparison of the redundancy, reliability, and responsiveness to change among SF-36, oswestry disability index, and multidimensional pain inventory. The Clinical Journal of Pain, 20, 133–142.CrossRefPubMed Wittink, H., Turk, D. C., Carr, D. B., Sukiennik, A., & Rogers, W. (2004). Comparison of the redundancy, reliability, and responsiveness to change among SF-36, oswestry disability index, and multidimensional pain inventory. The Clinical Journal of Pain, 20, 133–142.CrossRefPubMed
Metadata
Title
A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain
Authors
Whitney Scott
Katie E. J. Hann
Lance M. McCracken
Publication date
01-09-2016
Publisher
Springer US
Published in
Journal of Contemporary Psychotherapy / Issue 3/2016
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI
https://doi.org/10.1007/s10879-016-9328-5

Other articles of this Issue 3/2016

Journal of Contemporary Psychotherapy 3/2016 Go to the issue